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Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Illness Management and Recovery Workbook

Handout 9:
Getting Your Needs Met in the Mental Health System

“Everyone has different needs. Some folks may need one-to-one contact with a therapist and some folks may need a structured daily program. Find out what you need as an individual.

“It pays to be aware of the different kinds of services that are available to you. The last time I was in a crisis, the resource coordinator at the mental health clinic was very helpful.”

David Kime: artist, writer, and floral designer

Introduction

This handout provides an overview of the mental health system, including the services and programs available at many mental health centers. Information is provided to help people evaluate what programs they might like to participate in to further their own recovery. Strategies are provided to help people advocate effectively for themselves when they encounter a problem in the mental health system.

What are community mental health centers?

In the United States, Community Mental Health Centers (CMHCs) are the main source of public outpatient mental health services. In some states, the CMHCs provide services only to people who live in a certain geographic area. In other states, you may have a choice as to which CMHC you want to receive services from. Rates for services vary. People are charged based on insurance coverage, eligibility for medical assistance, and income.

It is important to keep in mind that in many states the mental health system is in the process of making extensive changes. For example, some public mental health services are now being provided by managed care organizations. Some of the changes may result in confusion about which services are being offered, who is eligible, and how to get access. Case managers and social workers usually have current information.

Psychiatrists and therapists are also available in the private sector, including private agencies, local hospitals, teaching hospitals, counseling agencies, and some employment programs. Private insurance and/or financial resources may be necessary to afford these services. However, some organizations, such as teaching hospitals, have special programs for providing mental health services that are more affordable.

What are some of the types of services offered by Community Mental Health Centers?

Community Mental Health Centers (or agencies that are affiliated with them) usually provide a wide range of services. If they do not provide the services you are looking for, they may be able to give you information on where to find them in your community. Your center may provide some of the following:

• Mental health evaluations
• case management
• medication services
• peer support or other consumer-led programs
• individual therapy
• group therapy
• social skills training
• family psychoeducation and other family services
• day treatment programs or partial hospital programs
• support groups
• education about mental illness
• emergency services
• occupational therapy
• recreational therapy
• employment services
• integrated mental health and substance use treatment
• access to Assertive Community Treatment Teams (ACT Teams)

Which services might be helpful to you?

The needs of people with psychiatric symptoms differ from one person to the next. Mental health centers often offer a variety of services to meet each person’s needs.

You may have already used some of the following services and may be interested in trying others. As you read the following descriptions of other people’s experiences, please check off the services that you would like to try.

• Mental Health Evaluation
  “It helped me to have a complete mental health assessment. I had been having problems for a while and going from one bad experience to another. I talked with the psychologist doing the assessment about the problems I’d been having. He also asked questions about what was going well in my life, what I’m good at, and what kind of support I have. It gave me a better perspective.”
  
• Case Management
  “I work closely with my case manager. When I need it, he helps me with all kinds of practical things, like helping me to apply for benefits and arranging for free transportation to my appointments. He also helped me find out what I needed to get involved in a supported employment program. He really knows the mental health system in and out.”
  
• Medication services
  “My doctor helped me to find the medication that I’m taking now. I tried a few kinds before I settled on this one. My doctor had a lot of experience, which really helped. Now I see her once a month.”
  
• Peer support/consumer-led programs
  “Going to a recovery program which was designed and led by people who had experienced psychiatric symptoms themselves was a key ingredient to my recovery. I got a chance to be with people who really understood me. I’ve also gotten a chance to help other people. It makes me feel much more confident and optimistic about the future.”
  
• Individual therapy
  “Having someone I can talk to about issues in my life is really important to me. My counselor helped me to sort out some problems I was having in my relationship with my boyfriend. She also encouraged me to go back to school, which I’m currently considering.”
  
• Group therapy
  “In my therapy group we talk about our feelings and different ways to cope with situations that come up in our lives. I feel comfortable talking with the people in the group about what’s on my mind.”
  
• Social skills training
  “I’ve learned a lot in my Social Skills Training group. I had been having trouble making friends, and being in the group taught me how to start conversations and keep it going. It also gave me a chance to try conversations in the group before I tried it at my job. The feedback from the other group members has been very helpful.”
  
• Family psychoeducation and other family services
  “I asked my Mom and Dad and brother to sign up with me for a family psychoeducation group at the Mental Health Center. It really helped to have them learn more about my illness. And it made us better able to talk together.”
  
• Day treatment or partial hospitalization program
  “I feel better when I have some structure every day. I like seeing people I know and having something to do. We have educational groups and leisure groups. I especially like the music groups.”
  
• Housing Options
  “I’m living in an apartment building that is owned by the Community Mental Health Center. I have my own apartment, but there is always a staff member around to help me if I need it. I like the other people in the building.”
  
• Support groups
  “Hearing from other people who have gone through similar things is very helpful to me. I don’t feel like I’m the only one. And the other people have good ideas that I can try out.”
  
• Emergency services
  “My mental health center has a 24 hour crisis line. I used it once when I was under a lot of stress, and it helped me stay in control.”
  
• Occupational therapy (O.T.)
  “Working with the occupational therapist helped me to get myself organized with shopping and cooking. Before that I was eating out all the time, which was really expensive.”
  
• Recreational Therapy (R.T.)
  “The recreational therapist helped me to get involved with my hobbies again. He encouraged me to get out my guitar and practice some songs. It’s been great to play music again.”
  
• Integrated mental health and substance use treatment
  “I used to get confused because my drug counselor told me one thing, and my mental health counselor told me another. Now we’re all working together and I’m making progress.”
  
• Employment services
  “I’m starting part-time work next week at a book store. The supported employment specialist asked me what kind of work I had done in the past and what I was interested in doing now. She helped me find a job that suited me. Now she’s going to stay involved while I’m working. I feel like I’ve got support for going
  back to work.”
  
• Assertive Community Treatment Team (ACT Team)
  “I used to be in and out of the hospital all the time. Now I have an ACT Team who helps me stay in the community. They help me with all kinds of things, including housing and transportation.”

Question: Which mental health services did you check off that you would like to try? You can record your answers on the following checklist:

Mental Health Services Checklist

How can you find out more about what is involved in participating in specific programs?

You may find out information about the key parts of these services from the community mental health centers, mental health research centers, consumer support agencies, and from advocacy groups. Some information is available on websites, and some can be found by checking your local phone book or by calling the offices of your state or county division of mental health.

Are you entitled to financial benefits?

Benefit programs are established to help members of our community when they are having financial difficulties. Sometimes people do not apply for these programs because they feel a sense of embarrassment attached to them. It is important to remember that you are part of a larger community and deserve to receive the financial and other supports that are intended to help people manage their lives.

Understanding and applying for benefits can be a complicated task. Talking with a case manager or social worker is a good way to find out what benefits you may be entitled to and how to apply for them. A case manager or social worker will also know of any recent changes in benefit programs.

Depending on your work history and current financial needs, you may qualify for one of the following financial benefits:

Social Security Disability Insurance (SSDI)

If you worked in the past and contributed to Social Security (or your disability started before you reached the age of eighteen) and are currently unable to work full-time because of mental illness, you may be eligible for SSDI. It is a federal program, and you can apply for it at the Social Security Administration Office. After two years of being eligible for SSDI, you might be eligible for Medicare health insurance.

Supplemental Security Income (SSI)

If you have not worked in the past (or are only eligible for a small amount of SSDI), are currently unable to work full-time because of mental illness, and have very limited financial resources, you may be eligible for Supplemental Security Income (SSI). It is a federal program, and you can apply at the Social Security Administration Office. If you receive SSI you may also be eligible for Medicaid health insurance.

Public Assistance

Each state offers different financial benefits and has different eligibility requirements. State benefit programs are often called “public assistance” or “temporary assistance for needy families” or “welfare programs.” If you have a low income and have mental health problems that interfere with working full-time, you may be eligible for public assistance. It is usually a modest amount of money.

Many states also have programs to assist with the purchase of food, such as food stamps. Many states and communities have programs to help with housing costs. The housing programs may be operated by local housing authorities or by the states.

Because public assistance is funded by the state, you would apply at the state Office of Public Assistance or Office of Public Welfare. You may also be eligible for Medicaid health insurance, which is sometimes called “medical assistance.”

Questions: Are you currently receiving financial benefits?
If not, do you think you might be eligible for SSDI, SSI or Public Assistance?

Are you entitled to health insurance benefits?

Social workers and case managers are usually well informed about health insurance benefits. The details about these benefits may vary from year to year, so it’s a good idea to start by talking to someone who knows the most recent information.

You may be eligible for one of the following health care benefits:

Medicare

If you are unable to work full-time because of mental illness and have been eligible to receive SSDI for more than two years, you may be eligible for Medicare. It usually covers inpatient and outpatient bills, although it is subject to deductibles, co-payments and “ceilings” for certain services. Medicare has two programs, Medicare A and Medicare B. You can get information about these programs from your local Social Security Office. Even if you are not sure that you will receive Medicare or Social Security, you have the right to apply. Applications are made at the Social Security Administration Office.

Medicaid

If you have a low income (or no income) and have mental health problems that interfere with working full-time, you may be eligible for Medicaid, which is called “Medical Assistance” in some states. Even though the programs vary from state to state, they usually cover inpatient and outpatient bills, and medication costs. In some states you are required to pay small co-payments and there are restrictions on reimbursements. You can apply at the State Office of Public Assistance or Office of Public Welfare.

Appealing Decisions

The Social Security Administration and local state programs (such as Medicaid) have ways that you can appeal decisions that have been made about whether you are eligible for services. When you apply, ask about what the appeal process is. If you feel a decision was not made correctly, you have a right to follow the appeal process.

Questions: Do you currently receive health insurance benefits?
If not, do you think you might be eligible for Medicare or Medicaid?

How can you advocate for yourself in the mental health system?

You may encounter a problem with the mental health system and may need to advocate for yourself. Here are some examples of problems that other people reported:

“I was on an endless list to see an individual counselor.”

“I wanted to get a job. I couldn’t find out how to get help with this.”

“I was ready to leave the day treatment program, but people kept telling me there was no alternative.”

When problems come up, the following guidelines may be helpful:

Keep a record of the details of the problem and what you have tried to do about it.
“I kept a copy of all my applications to the apartment program. Also, when I called someone at the housing office, I wrote down the date, who I spoke to, and what we talked about. I keep all the information together in a folder. It made it much easier to present my case to the apartment supervisor.”

Seek out the person on your treatment team who has the most experience in the type of problem you are having.
“I was frustrated about finding a job. I found out from my case manager that there is an employment specialist on my treatment team. I asked my case manager to refer me to work with that person. It’s moving the process along.”

Talk about your concerns calmly and clearly.
“I was getting very impatient about getting into an apartment. At first I used to get furious when I saw the housing coordinator in the hall. She was very uncomfortable when I raised my voice. Then I tried asking for an appointment and speaking more calmly. I even rehearsed what I was going to say before I went in. She was much more responsive.”

If you are not satisfied after speaking with the appropriate person, take additional action.
“Sometimes I don’t get results from talking to the designated person. I have learned to ask to speak to their supervisor or to go to the consumer advocate. Getting them involved usually helps.”

Follow through on actions that are your responsibility.
“When I went to the social worker about getting Social Security Disability (SSDI), he told me that I needed to get my employment records organized and bring them in so he could help me make the best case. I was the only one who knew where my records were, so if I didn’t bring them in, my social worker couldn’t proceed.”

Let people know that you appreciate their efforts.
“The nurse was pleased when I told her that I had tried her suggestions for coping with some of the side effects of my medication. She asked me to let her know if there was anything else I needed.”

If at first you don’t succeed, try, try again.
“I had to be persistent about getting transportation to the Artists-in-Recovery program. At first people said it wasn’t possible. But I was determined to attend the program, because I knew it was helping me. So I kept pursuing it, and I got other people to speak up for me. I finally
got transportation.”

Questions: Have you advocated for yourself in the mental health system?
If so, was it effective?

Who can you ask for help if you have a problem with the mental health system?

Mental health systems can seem huge and overwhelming. Even when you speak up for yourself, there may be times when it’s helpful to have someone to help you advocate for yourself.

In many mental health systems, someone is designated as a “consumer advocate” or “complaint investigator” to help people with problems they might be having with the system. It is a good idea to get to know the consumer advocate at your Mental Health Center. In some states, there is a state office of consumer affairs or consumer advocacy. It is useful to learn how to access this resource also. Often these offices have a staff that includes people who have experienced psychiatric symptoms who are working as advocates. They can help answer your questions and guide you though the advocacy process.

Sometimes people feel that they “get lost in the system.” To avoid that experience, it usually helps to find someone on your treatment team whom you feel comfortable talking to and whom you could turn to for help if you are having problems.

People usually feel most comfortable talking to someone who listens to their problems, asks questions, remembers what was said in past conversations, offers suggestions, and avoids critical or judgmental comments. Most people look for someone who seems to take an active interest in their well being.

The job title of the person with whom you feel comfortable will vary. Some people feel most comfortable talking with their case manager or their social worker or their psychiatrist. Other people feel most comfortable with their nurse or their psychologist or some other mental health worker.

Once you identify the person you feel comfortable with, it helps to keep him or her informed about how things are going with you. Let the person know both when things are going well and when things are not going well. Maintaining good communication will help the person be more effective if a problem comes up for you.

Questions:

Do you know the consumer advocate at your community mental
health center?

Who on your treatment team would you like to help you advocate
for yourself?

Are your needs being met by the mental health system?

You may or may not feel that your needs are being met by the mental health system. Answering the questions in the following chart could be helpful:

Questions About What I Receive From The Mental Health System

Summary of the main points about getting your needs met in the mental health system

• Community mental health centers are the main source of public outpatient mental health services.
• Mental health centers usually offer a wide range of services.
• Individuals vary widely in the mental health services they use.
• Depending on your work history and financial need, you may be eligible for financial benefits from Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or Public Assistance.
• Depending on your work history and financial need, you may be eligible for health insurance benefits from Medicare or Medicaid.
• Speak up for yourself if you encounter a problem in the mental health system.
• Get to know the consumer advocate at your mental health center.
• Identify someone on your treatment team to help you advocate for yourself if you encounter a problem with the mental health system.

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